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Insurance Process

Many insurance policies cover Bariatric Surgery procedures if they have such coverage and certain criteria are met. However there are many insurance policies that exclude bariatric surgery in their policy in which case your insurance company will NOT cover bariatric surgery under ANY circumstances even if it is medically necessary. Cash pay or Financing your procedure is the only available option for those patients.

First step is to verify your benefits on your policy and find out if your insurance has bariatric coverage. Our office will call your insurance carrier and obtain that information upon you submitting an online form authorizing us to do so. We will then update you with the information. If you have insurance coverage for bariatric surgery we will schedule a consultation under our insurance pathway.

After surgical consultation and accomplishing of all the insurance requirements the letter of medical necessity is prepared.

At this point we will be waiting for YOU to help us obtain:

  • Copies of previous weight loss attempt receipts
  • Past 5 year medical records from your physicians
  • Documentation of medically supervised weight loss if required by your insurance company
  • Any other evaluations as needed by your insurance (most often a psychological, nutritional and exercise evaluations are needed)
  • Any supporting letters from other physicians

Please note:

  • Once we obtain all documents and complete the package we will send all the information to your insurance company.
  • It can take anywhere from 1 – 3 weeks for your insurance company to respond back and sometimes longer. As soon as we hear from the insurance we will contact you.
  • Once an approval comes through we will move forward with the preoperative process and can schedule the surgery in about 2 weeks from the approval date.
  • If insurance needs additional documentation we will notify you and you then need to obtain the additional documentation necessary. We will help you with that process.
  • If insurance denied the application then you may appeal. However most appeals are denied unless you fulfill all the requirements by the insurance company and that we were able to provide documentation.
  • If insurance coverage is denied or insurance is not an option, then you may forward as cash pay. We can schedule your surgery date within 2-3 weeks from your decision to move forward as a self-pay patient.
  • We will work with your primary care physician to get most of the pre-operative testing done in order to minimize your out of pocket costs.
  • You may call our office or your insurance company at anytime in order to check the status of your application.
  • Our office will keep up with the insurance company in order to get expedited approval process on your behalf.